Unlike the other issues that I treat in my practice, I have included this section because many of the individuals referred to me for eating disorder treatment – nor their families, partners or friends – are well-versed with the facts.
I have also included links to pages about the most commonly asked questions about my experience and approach to working with adolescents and adults struggling with eating disorders, as well as to some great resources and videos. I hope that this section helps to begin to demystify the complexity of eating disorders.
What are eating disorders?
- Eating disorders are serious mental disorders that occur all over the world, particularly in industrialized regions or countries. They are NOT choices, passing fads or phases and they can be severe and fatal. They are treatable, and the sooner an individual gets the treatment he or she needs, the better the chance of a good recovery.
- The three main categories of eating disorders are anorexia nervosa, bulimia nervosa and binge eating disorder. Eating disorders can be recognized by a persistent pattern of unhealthy eating or dieting behavior that can cause health problems and/or emotional and social distress.
- Although there are formal guidelines that health care professionals use to diagnose eating disorders (DSM-5; APA, 2013), unhealthy eating behaviors and disordered eating exist on a continuum. Even if a person does not meet the formal criteria for an eating disorder, he or she may be experiencing unhealthy eating behaviors that cause substantial distress and may be damaging to both physical and psychological health (AED, 2014).
- Anorexia nervosa is characterized by a significantly low body weight and an intense fear of gaining weight or becoming fat. It is also distinguished by a disturbance in the way in which one body’s weight or shape is experienced, an undue influence of body weight or shape on self-evaluation, or the persistent lack of recognition of the seriousness of the current low body weight.
- There are two subtypes of anorexia nervosa. In the restricting subtype, people maintain their low body weight by restricting food intake and, sometimes, by exercise. Individuals with the binge-eating/purging type also restrict their food intake, but regularly engage in binge-eating and/or purging behaviors such as self-induced vomiting or the misuse of laxatives. Many people move back and forth between subtypes during the course of their illness (DSM-5, APA, 2013).
Bulimia nervosa is characterized by recurrent episodes of binge eating, in a discrete period of time (eg, 2 hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. These episodes are marked by a sense of lack of control. These binge eating episodes are followed by inappropriate compensatory behaviours in order to prevent weight gain, such as self- induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
Binge eating and inappropriate compensatory behaviour both occur, on average, at least once a week for 3 months and the individual’s self-evaluation is unduly influenced by body shape and weight (DSM-5, APA, 2013).
Binge Eating Disorder
- Binge eating disorder is characterized by recurrent episodes of binge-eating (same as bulimia nervosa), but is not associated with the recurrent use of inappropriate compensatory behaviours to counteract the binges.
- Binge eating episodes are associated with three or more of the following:
eating much more rapidly than normal; eating until feeling uncomfortably full; eating large amounts of food when not feeling physically hungry; eating alone because of embarassment; and/or feeling disgusted with oneself, depressed, or very guilty after overeating. Binge eating disorder is marked by distress regarding the binge eating and these episodes occur at lease once a week for 3 months (DSM-5, APA, 2013).
Other Specified Feeding or Eating Disorder (OSFED)
OSFED would include: atypical anorexia nervosa; subthreshold bulimia nervosa; subthreshold binge eating disorder, purging disorder and night eating syndrome (DSM-5, APA, 2013).
Avoidant/Restrictive Food Intake Disorder (ARFID)
ARFID, which may be diagnosed in children, adolescents or adults, is characterized by an eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one or more of the following: a significant weight loss (or failure to achieve expected weight gain or faltering growth in children); a significant nutritional deficiency; a dependence on enteral feeding or oral nutritional suppliments; and/or a marked interference with psychosocial functioning. ARFID is not better explained by a lack of available food or culturally sanctioned practices, or by another medical condition or mental disorder. It is not AN or BN and there is no body image distortion (DSM-5, APA, 2013).
Early signs of eating disorders
- Fear of gaining weight
- Preoccupation with food
- Feeling out of control while eating
- Intentionally vomiting after eating
- Eating in secret
- Feeling intense guilt after eating
- Using laxatives or diuretics
- Excessively exercising
- Body checking
- Chronic dissatisfaction with one’s appearance
Who may be affected by eating disorders?
- Anyone can be affected. Eating disorders do not discriminate on the basis of sex, age, or race. They can be found in both sexes, all age groups, and across a wide variety of races and ethnic backgrounds around the globe. But there are groups who display an increased risk for eating disorders (AED, 2014).
Who is at increased risk for eating disorders?
- Eating disorders are more common in women, but they do occur in men. Rates of binge eating disorder are similar in females and males.
- Athletes in certain sports are at particularly high risk for eating disorders. Female gymnasts, ice skaters, dancers, and swimmers, to name a few, have been found to have higher rates of eating disorders. In a study of top student athletes, over one-third of female athletes reported attitudes and symptoms placing them at risk for anorexia nervosa. Male athletes are also at increased risk especially those in sports such as wrestling, bodybuilding, crew, running, cycling, climbing, and football (AED, 2014).
How common are eating disorders?
- Anorexia nervosa: Between 0.3 and 1% of young women have anorexia nervosa.
- Bulimia nervosa: Around 1 to 3% of young women have bulimia nervosa.
- Binge Eating Disorder: Around 3% of the population has binge-eating disorder.
- Between 4% and 20% of young women practice unhealthy patterns of dieting, purging, and binge-eating.
- Currently, about one in 20 young women in the community has an eating disorder (AED, 2014).
What causes eating disorders?
- Eating disorders are complex and are influenced by BOTH genetic AND environmental (i.e., pressure to be thin, trauma, etc.) factors. Eating disorders are NOT simply caused by Western cultural values of thinness although those factors are operative.
- While the current Western obsession with slimness and the glamorous portrayal of emaciated women in the media may play a role in the recent increase of eating disorders, genetic vulnerability, personality, psychological and environmental factors all contribute to the causes of eating disorders (AED, 2014).
How devastating are eating disorders?
- For women aged 15-24, eating disorders are among the top four leading causes of burden of disease in terms of years of life lost through death or disability.
- Anorexia nervosa has one of the highest overall mortality rates and the highest suicide rate of any psychiatric disorder. The risk of death is three times higher than in depression, schizophrenia or alcoholism and 12 times higher than in the general population. Up to 10% of women with anorexia nervosa may die due to anorexia-related causes. Early recognition of symptoms and proper treatment can reduce the risk of death. Deaths in anorexia nervosa mainly result from complications of starvation or from suicide.
- Health consequences such as osteoporosis (brittle bones), gastrointestinal complications, and dental problems are significant health and financial burdens throughout life. Furthermore, quality of life is severely impaired in all eating disorders (AED, 2014).
Can one recover from an eating disorder?
- In general, early detection and treatment are associated with a better chance of recovery. One reason for this may be that brain development is not complete until about age 20 and the effects of starvation on the developing brain are particularly noxious.
- Anorexia nervosa: Over a 10-year period, about half of those with anorexia nervosa recover fully, a small percentage continues to suffer from anorexia nervosa, and the rest develop other eating disorders. Even among those individuals who recover from an eating disorder, it is common for them to continue to maintain a low body weight and experience depression.
- Bulimia nervosa: More than half of those treated for bulimia nervosa have recovered at follow-up (AED, 2014).